Common Workers’ Compensation Terms

A

Accepted
claim: A claim for injuries in which the insurer agrees your injury or
illness is covered by workers’ compensation insurance.

Accident: See
NRS 616A.030

Accident
Benefit: See NRS 616A.035

Adjuster: See
NAC 616A.015

American
Medical Association (AMA): A national physician’s group which
publishes a set of guidelines called “Guides to the Evaluation of Permanent
Impairment.” In Nevada, any permanent disability is rated under the 2005
guide’s rating schedule.

Americans
with Disabilities Act (ADA): A federal law that prohibits
discrimination against people with disabilities. If you believe you’ve been discriminated
against at work because you’re disabled and want information on your rights
under the ADA, contact a U.S. Equal Employment Opportunity Commission office.
For the EEOC office in Nevada, call 1-800-669-4000 or 1-800-669-6820 (TTY).

Appeals
Officer (AO): See NAC 616A.040

Apportionment: A
way of figuring out how much of your permanent partial disability is
attributable to your current work injury claim and how much is due to other
disabilities.

Average
Monthly Wage: See NRS 616A.065

B

Benefit: A
service or right obtained through a workers’ compensation claim.

Benefit
Penalty: See NRS 616A.070

C

C-1 Form
(Notice of Injury or Occupational Disease): Form used to notify your
employer of an injury or occupational disease (OD) arising out of and in the course
and scope of your employment, You must provide written notice to your employer
as soon as practicable, but no later than 7 days after the accident or OD.

C-3 Form
(Employer’s Report of Industrial Injury or OD):

C-4 Form
(Claim for Compensation): If medical treatment is sought for an injury
arising out of the course and scope of employment, a medical provider must
complete a C-4 form. The treating physician or chiropractor must, within 3
working days after treatment, complete and mail to the employer, the employer’s
insurer and third-party administrator, the C-4 form. The form must be filed
within 90 days after an accident or OD.

Casual: See
NRS 616A.075

Catastrophic
Injury: See NRS 616A.077

Certified
Vocational Rehabilitation Counselor: See NRS 616A.080

Claimant: See
NAC 616A.060

Claims
Adjuster: An individual who handles workers’ compensation claims
for an insurance company, third party administrator or self-insured employer.

Claims
Examiner: See Claims Adjuster.

Compensation: See
NRS 616A.090

D

Damages: See
NRS 616A.095

Date of
Injury: When you got hurt or ill. If your injury was caused by one
event, the date it happened is the date of injury. If the injury or illness was
caused by repeated exposures, the date of injury is the date you knew or should
have known the injury was caused by work.

Death
Benefits: Benefits paid to surviving dependents when a work injury or
illness results in death.

Denied
Claim: A claim in which the insurance company believes your injury or
illness is not covered by workers’ compensation and has notified you of the
decision.

Decision
& Order: A written decision by a Hearing officer or Appeals
Officer which either affirms, reverses or remands a prior determination.

Disability: A
physical or mental impairment that limits your life activities. A condition
that makes engaging in physical, social and work activities difficult.

E

Ex parte
communication: A private communication with a judge regarding a
disputed matter without the other party being present or copied with
correspondence. An Ex-Parte communication is generally not allowed.

F

Family
and Medical Leave Act (FMLA): A federal law that provides certain
employees with serious health problems or who need to care for a child or other
family member with up to 12 weeks of unpaid, job-protected leave per year. It
also requires that group health benefits be maintained during the leave. For
more information, contact the U.S. Department of Labor at 1-866-4-USA-DOL.

Final
order: Any order, decision or award made by a workers’ compensation
judge that has not been appealed in a timely way.

Foot: See
NRS 616A.240

Fraud: Any
knowingly false or fraudulent statement for the purpose of obtaining or denying
workers’ compensation benefits. The penalties for committing fraud are fines up
to $150,000 and/or imprisonment for up to five years.

H

Hand: See
NRS 616A.245

Hearings: Legal
proceedings in which a workers’ compensation judge discusses the issues in a
case or receives information in order to make a decision about a dispute or a
proposed settlement.

Independent
medical examiner (IME): For injuries occurring on and after January 1,
1991, whenever the term “independent medical examiner” is used, the term shall
mean “qualified medical examiner.”

Impairment
rating: A percentage estimate of how much normal use of your injured
body parts you’ve lost. Impairment ratings are determined based on guidelines
published by the American Medical Association (AMA). An impairment rating is
used to calculate your permanent disability rating but is different from your
permanent disability rating.

In the
course & scope of employment: Your injury must be caused by and
happen on the job.

Injury: See
NRS 616A.265

Insurer: See
NRS 616A.270

J

Judge: Term
used to describe the Hearing officer or appeals officer

L

Light
Duty: See modified duty

M

Manual: See
NAC 616A.170

Maximal
medical improvement (MMI): Your condition is well stabilized and
unlikely to change substantially in the next year, with or without medical
treatment. Once you reach MMI, a doctor can assess how much, if any, permanent
disability resulted from your work injury.

Medical
care: See medical treatment.

Medical
Facility: See NRS 616A.273

Medical
treatment: Treatment reasonably required to cure or relieve the
effects of a work-related injury or illness. Also called medical care.

Modified
Duty Position: If your treating physician provides you with a written
modified duty release that does not allow you to perform your pre-accident job
duties, your employer your employer may extend a modified duty job that is
within the restrictions placed by your treating physician. See NRS 616C.475(8)
and NAC 616C.583.

N

Nevada
Administrative Code (NAC): The Nevada Administrative Code (NAC)
contains the Regulations concerning the Workers Compensation Statutes. The
Regulations help define, explain and enact the various provisions of the
Statutes.

Nevada
Revised Statutes (NRS):

Notice of
hearing: The formal written notice provided by the Hearings and
Appeals Divisions that is sent to all interested parties that indicates the
date, time and place that the hearing shall take place.

P

Party: Normally
this includes the insurance company, your employer, attorneys and any other
person with an interest in your claim (doctors or hospitals that have not been
paid).

Patient: See
NAC 616A.190

Permanent
and stationary: See stable and Ratable

Permanent
Partial disability: Any lasting disability that results in a reduced
earning capacity after maximum medical improvement is reached.

Permanent
Partial disability rating (PPD): A percentage that estimates how much
a job injury permanently limits the kinds of work you can do. It is based on
your medical condition, date of injury, medical records, medical examination.

Permanent
Partial disability (PPD) benefits: Payments you receive when your work
injury permanently limits the kinds of work you can do or your ability to earn
a living.

Permanent
disability payments: A mandatory bi-weekly payment based on the
undisputed portion of permanent disability received before and/or after an
award is issued.

Permanent
total disability (PTD) benefits: Payments you receive when you are
considered permanently unable to earn a living.

Physician:

PPR
(Physicians Progress Report):

Primary
treating physician (PTP): The doctor having overall responsibility for
treatment of your work injury or illness. This physician writes medical reports
that may affect your benefits. Also called treating physician or treating
doctor.

Proof of
service: A form used to show that documents have been sent to specific
parties.

Q

R

Rating: See
permanent partial disability rating.

Reconsideration: See
petition for reconsideration.

Restrictions: See
work restrictions.

S

Self-insured
Employer – See NRS

Social
Security disability benefits: Long-term financial assistance for
totally disabled persons. These benefits come from the U.S. Social Security
Administration. They are reduced by workers’ compensation payments you receive.

Stable
& Ratable: Your medical condition has reached maximum medical
improvement. Once you are stable and ratable, a doctor can assess how much, if
any, permanent disability resulted from your work injury.

Subjective
factors: The amount of pain and other symptoms described by an injured
worker that a doctor reports as contributing to a worker’s permanent
disability.

Subpoena: A
document that requires a witness to appear at a hearing.

Subpoena
Duces Tecum (SDT): A document that requires records be sent to the
requester.

T

Temporary
partial disability (TPD) benefits: Payments you get if you can do some
work while recovering, but you earn less than before the injury.

Temporary
total disability (TTD) benefits: Payments you get if you cannot work
at all while recovering.

Third
Party Administrator: See NRS 616A.335

Total
Disability: See NRS 616A.340

“Trade.
Business, Profession or occupation of his or her employer”: See NRS 616A350

Transportation
expenses: A benefit to cover your out-of-pocket expenses for mileage,
parking and toll fees related to a claim. Usually a reimbursement.

Treating
doctor: See primary treating physician.

Treating
physician: See primary treating physician. Treating
physician: A physician that can treat your work injury if you advised your
employer in writing prior to your work injury or illness and certain conditions
are met.

U

V

Vocational
rehabilitation (VR): See NAC 616A.270

Vocational
rehabilitation maintenance allowance (VRMA): Payments to help you with
living expenses while participating in vocational rehabilitation. See
vocational rehabilitation.

Vocational
Rehabilitation counselor:

Vocational
Rehabilitation Services: See NRS 615.140

W

Work
restrictions: A doctor’s description of the work you can and cannot
do. Work restrictions help protect you from further injury.